Deborah B. Reed

Agricultural injuries among older Kentucky farmers : The Farm Family Health and Hazard Surveillance Study

This population-based study reports the cumulative incidence of agricultural injuries during a 1-year period in a sample of 998 farmers aged 55 years and older living in Kentucky. A total of 98 farm-related injuries were reported among 88 older farmers for a crude injury rate of 9.03 injured farmers per 100 farmers (95% confidence interval (CI) = 7.03-11.03) over a 1-year period. The leading external causes of farm injury were falls (24.9%), machinery (22.5%), wood-cutting (14.6%), and animal-related events (14.3%). Farmers working on farms with beef cattle (alone) (odds ratio = 1.90; 95% CI = 1.02-3.55) or farms with beef cattle and tobacco (odds ratio = 2.15; 95% CI = 1.00-4.59) had a statistically significant increased risk for a farm-related injury. Farmers reporting a prior injury that limited their ability to farm were at increased risk for a farm-related injury. Approaches to using farm injury surveillance data for injury control programs in the state are discussed.

Nonfatal Farm Injury Incidence and Disability to Children A Systematic Review

OBJECTIVE To summarize the literature on farm child nonfatal injury incidence and the subsequent disability to children. SEARCH STRATEGY We used a systematic process to search the following databases: MEDLINE, EMBASE, ERIC, NTIS and NIOSHTIC. The reference lists from each potentially eligible study were checked and experts in the field contacted for additional reports. SELECTION CRITERIA Studies for selection had to meet the following criteria: published in the last 20 years (1979-1998); located in North America; and include nonfatal farm injury cases for children under age 20. DATA COLLECTION AND ANALYSIS Thirty-two studies met the inclusion criteria and were examined for study design, location, sample size, injury rate, injury sources, and functional outcomes. RESULTS Among the 32 studies, there were 9 case series, 11 secondary analyses of administrative databases, 2 case-control studies, 6 cross-sectional surveys, one mixed-method study, 2 prospective case series reports, and 1 cohort study. Twenty-two of the studies confined the sample to agriculture, but nine of these combined children within a larger sample, creating considerable difficulty in examining only agricultural injuries to children. Only one study focused on outcome measurement. Although nearly all the reports provided some discussion about injury severity, these comments were generally limited to injury severity scores or injury type. CONCLUSIONS Despite increasing attention on farm-related child injury, the literature continues to report primarily descriptive studies that rely on small samples focusing on the nature of the injury event and immediate consequences. Analysis of larger databases, such as worker compensation claims, trauma registries, and agricultural injury surveillance, still lacks valid denominators; thus, incidence rates cannot be calculated. Very little was found regarding disability among children who experienced agricultural injury, even though the literature clearly proclaims the severity and seriousness of child injury on farms. To complete the portrait of the burden of this continuing problem, research must include functional outcome measures.

Women in agriculture: risks for occupational injury within the context of gendered role

Women continue to make significant contributions to farming. Not only do women participate in the traditional roles of homemaker, caregiver, and wife, they also work side-by-side with their spouses in keeping the farm viable. More daughters are entering the farming business, either as partners with other family members or as independent operators. Each year since the United States Department of Agriculture began including gender in the Census of Agriculture, the percentage of women engaged in agriculture has increased, and womens participation in agriculture is increasing faster than in other business segments. This article examines the role of women in agriculture and how sociocultural, economic, and physical factors may affect womens exposure to injury-producing events and their knowledge and beliefs about injury prevention. To date, few studies have examined work-related unintentional injuries among farm women. Even less is known about the extent to which occupational risks are recognized when women seek medical care. Differences in size and stature, increased physical strain, and low maximal oxygen uptake may predispose women to ergonomic-related injuries. Limitations of current research and recommendations for future analyses are discussed.

Sleep deprivation and injuries in part-time Kentucky farmers: impact of self reported sleep habits and sleep problems on injury risk.

Part-time farmers who hold off-farm jobs may be at risk for injuries because of impaired performance resulting from inadequate sleep. For this study, 1,004 part-time male Kentucky farmers completed a telephone interview for the 1994 to 1995 National Institute for Occupational Safety and Health-funded Farm Family Health and Hazard Surveillance Project. Questions were included about demographics, sleep habits, and injury occurrence. Twelve percent of the farmers reported an injury requiring medical intervention in the previous year. Farmers reported sleeping an average of 7.6 hours daily. Approximately 6.7% of the sample had three symptoms of sleep apnea. Although hours of sleep were not related to injury incidence, sleep medication use (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.01 to 4.40) and presence of three sleep apnea symptoms (OR = 2.48, 95% CI = 1.13 to 5.41) were related to injury incidence. These data support the need for further research to examine sleep habits and promote strategies that reduce the risk for injuries caused by lack of sleep

The Hidden Work of the Farm Homemaker

Despite women’s involvement in agricultural production, the work role of women residing in farm households has not been thoroughly examined. Data collected in 1994-1995 as part of the NIOSH-sponsored Farm Family Health and Hazard Surveillance Project were used to address task issues and health status of farm women in Kentucky. In 1996, the farm woman component of the Kentucky study was replicated in five counties in west Texas, allowing an examination of farm women in two large agricultural states. The Kentucky study employed a two-stage cluster design; the Texas study was based on a systematic quota sample of farms. Both studies selected a sample of women aged 18 years and older living in farm households. A total of 992 women in Kentucky (response rate = 85%) and 665 women in Texas completed a structured 30-min telephone interview on work roles, health status, injuries, and demographics. The results indicated that although 46.4% of the Kentucky respondents and 46.3% of the Texas respondents characterized themselves as farm homemakers, they regularly engaged in farmwork. Reported tasks included work with animals, tobacco-related chores, field irrigation, farm equipment operation, and farm management. Further, women who characterized themselves as homemakers reported rates of farm injuries that were comparable with women who classified themselves in other roles such as full agricultural partners. Role definition may influence the woman’s perception of risk on the farm, preclude participation in farm safety programs, and prevent an accurate occupational medical history. This two-state descriptive study highlights the hidden work role of the farm woman—a role that remains invisible to the farm woman herself—and emphasizes the important occupational exposures that farm women encounter.

Agricultural Disability Awareness and Risk Education (AgDARE) for high school students

Objective—Develop and test a farm health and injury prevention educational intervention for high school agriculture students. Setting—Twenty one high schools in Kentucky, Iowa, and Mississippi. Methods—A quasiexperimental crossover design was used to test the effectiveness of two sets of instructional materials designed through participatory action research with agriculture teachers and students. Narrative simulations based on farm work stories and simulations of farm work while students pretended to have a disability were completed in 14 schools (n = 373) over the academic year. Students in seven control schools (n = 417) received no intervention but completed, in the same time frame as students in the treatment schools, demographic surveys and pre-measures and post-measures of farm safety attitudes and intent to change safety behaviors. One year after the intervention, 29 students from the treatment group received farm visits to measure their farm safety behaviors. Results—Students engaged in hazardous work on farms. Thirty two were involved in tractor overturns and 11 had received injuries from rotating power take-off mechanisms. One fourth reported hearing problems, and 21% had respiratory symptoms after working in dusty farm surroundings. Students who completed at least two physical and two narrative simulations of the Agricultural Disability Awareness and Risk Education (AgDARE) curriculum showed statistically significant positive changes in farm safety attitude and intent to change behaviors. Conclusions—Adolescents engage in farm work that places them at risk for injury and illness. The AgDARE curriculum may be an effective and efficient method of teaching farm safety in high school agriculture classes.

Understanding and meeting the needs of farmers with amputations.

BACKGROUND Despite the hazardous nature of the occupation, farmers who sustain serious permanently disabling injuries return to the physical labor of production agriculture. It is estimated that amputations account for 11% of all major farm-related injuries. PURPOSE This report describes the process of reentry to farm work of farmers across the United States who experienced above-the-wrist traumatic amputations. SAMPLE Interviews with 16 farmers revealed the unique features of the work and world view of these workers who labor in the fields. FINDINGS The occupational recovery process included questioning, analyzing, and “getting along.” Prostheses and formal rehabilitation programs were viewed as minimally helpful. Suggestions and resources that may be helpful for the orthopaedic nurse to assist this high-risk work group are included.

Farm Elders Define Health as the Ability to Work

Thirty percent of Americas 2.2 million farms are operated by individuals older than 65 years. This study examined how older farmers define health and determined whether demographic characteristics, farm work, and physical and mental health status predict health definition. Data were collected via telephone and mailed surveys during the baseline wave of data collection in a longitudinal study of family farmers residing in two southern states (n = 1,288). Nearly 42% defined health as the “ability to work” compared to a physical health-related definition. Predictors of defining health as the ability to work included being White, performing more farm tasks in the past week, taking prescription medications daily, and having minimal health-related limitations to farm work. Health behaviors are centered on the individuals perception of health. Understanding the defining attributes of health can support better approaches to health care and health promotion, particularly among rural subcultures such as farmers, whose identity is rooted in their work.

Agricultural tasks and injuries among Kentucky farm children: results of the Farm Family Health and Hazard Surveillance Project.

Background This population-based study reports the prevalent agricultural tasks and the 1-year cumulative incidence of injuries in a sample of 999 children ≤18 years old living on family farms in Kentucky. Methods Data were collected in 1994 to 1995 for the National Institute for Occupational Safety and Health Farm Family Health and Hazard Surveillance Project. A random sample of farm children in 60 Kentucky counties was selected using a cross-sectional, two-stage cluster design. Respondents, primarily mothers, completed a 30-minute telephone interview about work-related tasks and injuries experienced by their children while working on the farm. Results Participation in chores related to tobacco and beef cattle production was common for children aged 5 to 18 years. In a 1-year period, 29 children were injured while performing farm work, yielding a crude rate of 2.8 per 100 children (95% confidence interval, 1.7–3.8). Boys aged 16 to 18 years had the highest injury rate (9.2 per 100 children). Farm machinery, cattle and horses, falls from heights, and contact with inanimate objects were the primary external causes of nonfatal farm work injuries. Conclusion Rates of farm work injuries among adolescent boys may be higher than previously reported for Kentucky and other states. Injury prevention interventions targeted to chores related to tobacco and beef cattle production are particularly relevant for this population of young workers.

Obstructive Sleep Apnea Indicators and Injury in Older Farmers

ABSTRACT The purpose of this study was to explore the relationship between sleep apnea indicators and injury in older farmers from Kentucky and South Carolina. Participants reported at least 1 day of farm work during the preceding year (n = 756) and received income from farming. The primary outcome variable was occurrence of injuries because of farm work in the past year. Main explanatory variables of interest included snoring, gasping, snorting, or cessation of breathing while asleep; trouble sleeping; consumption of sleep medications; trouble staying awake during daytime; and sleep quality. Simple logistic regressions established bivariate associations between explanatory and outcome variables. Explanatory variables significantly associated with the outcome in the bivariate analyses were used to fit a multivariable logistic regression model. The results show that just over 10% of participants experienced a farm injury in the past year. Significant bivariate associations were detected between the occurrence of injuries and number of days of farm work (odds ratio [OR] = 1.003, p = .0002); number of hours of farm work during the last week (OR = 1.017, p = .0047); male gender (OR = 2.48, p = .0007); arthritis or rheumatism conditions (OR = 1.981, p = .004); stopped breathing while sleeping (OR = 2.338, p = .0027); and problems staying awake during the past month (OR = 2.561, p = .001). In the final multivariable model, “stopping breathing while asleep” (p ≤ .05) and “problems staying awake last month” (p ≤ .01) were retained. These results show that sleep problems were associated with injury in this sample of older farmers. Future studies are necessary to screen and diagnose older farmers with obstructive sleep apnea (OSA) to empirically determine the effect of this sleep disorder on injury.